Preferred method of treatment
for advanced
ovarian cancer announced
The National Cancer Institute (NCI), part of the National Institutes
of Health, recently issued an announcement encouraging treatment with anti-cancer
drugs via two post-surgery methods for women with advanced ovarian cancer.
The combined methods, which deliver drugs into a vein and directly into the
abdomen, extend by about a year overall survival for women with advanced ovarian
cancer. The University of Colorado Cancer Center (UCCC) participated in the
NCI-supported clinical trials that led to this announcement.
The clinical announcement to surgeons and other medical professionals
who treat women with ovarian cancer was made with the support of six professional
societies and advocacy groups. The announcement coincides with the publication
in the New England Journal of Medicine of the results of a large clinical
trial by Deborah Armstrong, MD, medical oncologist and an associate professor
at Johns Hopkins Kimmel Cancer Center in Baltimore, and her colleagues in
an NCI-supported research network known as the Gynecologic Oncology Group
(GOG). This is the eighth trial evaluating the use of chemotherapy delivered
into the abdomen for ovarian cancer. Together, these trials show a significant
improvement in survival for women with advanced ovarian cancer.
“
Treatment for women with ovarian cancer continues to improve,” said
Dr. Susan Davidson, a gynecologic oncologist at UCCC who contributed to the
studies. “We are grateful to the women who participated in these studies.”
The two treatment methods are called intravenous, or IV, for chemotherapy
delivered into a vein and intraperitoneal, or IP, for chemotherapy delivered
into the abdominal or peritoneal cavity. The Armstrong trial involved 429
women with stage III ovarian cancer who were given chemotherapy following
the successful surgical removal of tumors.
It compared two treatment regimens:
1) IV paclitaxel followed by IV cisplatin, to 2) IV paclitaxel followed by
IP cisplatin and the subsequent administration of IP paclitaxel.
“
IP therapy is not a new treatment approach, but it has not been widely
accepted as the gold standard for women with ovarian cancer," Armstrong
said. “There has been a prejudice against IP therapy in ovarian cancer
because it's an old idea, it requires skill and experience for the
surgery and for the chemotherapy, and it's more complicated than
IV chemotherapy. But now we have firm data showing that we should use a combination
of IP and
IV chemotherapy in most women with advanced ovarian cancer who have
had successful surgery to remove the bulk of their tumor.”
Standard treatment for women with stage III ovarian cancer has been
surgical removal of the tumor (debulking), followed by six to eight courses
of IV chemotherapy given every three weeks with a platinum drug, such as cisplatin
or carboplatin, and a taxane drug, such as paclitaxel. Platinum and taxane
are two classes of anticancer drugs. The new NCI clinical announcement recommends
that women with advanced ovarian cancer who undergo effective surgical debulking
receive a combination of IV and IP chemotherapy. IP chemotherapy allows higher
doses and more frequent administration of drugs, and it appears to be more
effective in killing cancer cells in the peritoneal cavity, where ovarian
cancer is likely to spread or recur first.
“
In our trial, women who received part of their chemotherapy via an
IP route had a median survival time 16 months longer than women who received
only IV chemotherapy,” Armstrong said. The 205 women treated via the
IP route fared better, even though most of them received fewer than
the six planned treatments. Complications associated with the abdominal
catheter used
to deliver the IP chemotherapy were the main reason only 86 of the
women completed all six IP treatments. Women who received IP chemotherapy
had more side effects
than those treated with IV chemotherapy alone, but most side effects
were temporary and easily managed. One year after treatment, women
in both study
groups had the same reported quality of life.
“Randomized, multi-center clinical trials, including this most recent study,
clearly show the value of IP chemotherapy – an extended life for women
with advanced ovarian cancer,” said Philip DiSaia, MD, chairman of the
GOG.
Beth Karlan, MD, president of the Society of Gynecologic Oncologists and director
of Gynecologic Oncology and the Gilda Radner Ovarian Cancer Program at Cedars-Sinai
Medical Center in Los Angeles, added, “For most women who have had successful
surgical removal of tumors to less than one centimeter in size, we now know that
the longest survival may be achieved by giving their chemotherapy directly into
the abdomen.”
More studies are needed to determine the best IP drug regimen and the optimal
number of IP treatments. Future trials also will address how to reduce toxicity
associated with IP administration.
In addition to continued research to improve ovarian cancer treatment, NCI is
funding studies to identify disease markers and develop improved screening techniques,
enabling earlier detection and treatment of the disease.
An estimated 22,220 women in the United States were diagnosed with ovarian cancer
in 2005. It causes more deaths in the United States than any other cancer of
the female reproductive system, with an estimated 16,210 women dying from the
disease in 2005.
The most recent statistics show that only 45 percent of women
survive five years after being diagnosed with ovarian cancer; the rate increases
to 94 percent when the disease is diagnosed before it has spread. However, women
with ovarian cancer frequently have no symptoms or only mild symptoms until the
disease is advanced. As a result, only 19 percent of all cases are detected at
that early, localized stage.
Additional information on IP chemotherapy, including administration, as well as other resources for clinicians and patients can be obtained at http://www.gog.org, http://onsopcontent.ons.org/Toolkits/Chemotherapy/ and http://www.ons.org/patientEd/Treatment/chemotherapy.shtml.
